Long-term work ability, cognitive impairments and work-related concerns among young adult cancer survivors: a comparative analysis with healthy controls (AYA-LE study)

Cancer can substantially disrupt the career paths of adolescent and young adult cancer survivors (AYA-CS). However, little is known about the long-term impact of cancer on their work life compared to healthy peers without a history of cancer. As part of the AYA-LE study, we surveyed AYA-CS (aged 18–39 years at time of diagnosis) and healthy controls (HC). A multivariate analysis of covariance (MANCOVA) was conducted to compare work ability (Work Ability Index), cognitive impairments (COPSOQ) and work-related concerns between groups, controlling for differences in age, gender and educational level. Predictors of work ability were analyzed on average 4 years after diagnosis (t3) using hierarchical regression analyses. A total of 438 AYA-CS and 406 HC participated in the study. AYA-CS reported significantly lower work ability (M = 35.73 ± 0.35 vs. M = 39.17 ± 0.35; p < 0.001, ηp² = 0.06) and more severe cognitive impairment (M = 34.88 ± 1.08 vs. M = 29.15 ± 1.10; p < 0.001, ηp² = 0.02) than HC. They also reported more work-related concerns about reduced income, unemployment, limited career advancement and early retirement (all p < 0.001). In AYA-CS, lower work ability at t3 was associated with older age, metastatic or recurrent disease, more severe cognitive impairment, greater effort to cope with the disease, less employer support, and participation in rehabilitation measures (adj. R² = 0.59), with cognitive impairment and effort to cope with the disease emerging as the strongest predictors of work ability. AYA-CS continue to experience poorer work outcomes than their peers without cancer, even years after diagnosis. Our findings emphasize the need for early identification of at-risk survivors and for interventions addressing cognitive impairments, coping demands, and workplace support to sustain and improve work ability in this population.